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Biomedical subjects

G H Lipscomb

Publications and source records attributed to G H Lipscomb.

36 records · Page 2Linked to original sources
PubMed1994

A randomized comparison of the Pipelle, Accurette, and Explora endometrial sampling devices.

OBJECTIVES: Our aim was to compare the Pipelle, Accurette, and Explora endometrial sampling devices. STUDY DESIGN: Patients (n = 248) undergoing endometrial biopsy were randomized to one of the three sampling instruments. Diagnostic accuracy, ability to obtain sufficient tissue for histologic diagnosis, and patient discomfort during sampling of the three devices were compared. When available, endometrial biopsy specimens were compared with subsequent pathologic findings at hysterectomy. Statistical analysis was performed with one-way variance of the means, chi 2, and Kruskal-Wallis statistic. RESULTS: In successful biopsies there was no statistical difference among groups in specimen adequacy and there was no discrepancy between endometrial biopsy and hysterectomy pathologic findings. However, 42% of Accurette biopsies either were failed attempts or obtained insufficient tissue (p < 0.01). Pain scores were similar among the groups. CONCLUSION: The results with the Pipelle and Explora endometrial samplers appear to be comparable. However, given a 42% unusable specimen rate, the Accurette cannot be recommended for routine endometrial sampling.

Adult↗
PubMed1994

Instruction in surgical anatomy for gynecology residents using prosected human cadavers.

Prosected human cadavers were used by a team of anatomists and gynecologic surgeons to teach surgical anatomy to gynecology residents. The course was offered at the start of each 8-week gynecologic surgery rotation. Hemisections and other similar prosections were used to demonstrate anatomic relationships and surgical procedures from vantage points unobtainable at the operating table. The initial response from the faculty and residents was encouraging. The residents believed the program to be beneficial and were satisfied with it. Both the anatomy faculty and the gynecology faculty found new insights into teaching issues during the interdisciplinary process of course preparation and teaching.

Anatomy↗
PubMed1994

Serum bupivacaine levels during laparoscopic sterilization using local anesthesia.

STUDY OBJECTIVE: To determine the serum levels of bupivacaine during laparoscopic sterilization when bupivacaine 0.5% without epinephrine is used as the sole local anesthetic agent. DESIGN: Case series. SETTING: Regional medical center and primary teaching hospital of Ob/Gyn Department of the University of Tennessee, Memphis. PATIENTS; Thirty women undergoing laparoscopic sterilization with bupivacaine for local anesthesia. INTERVENTIONS: Venous serum bupivacaine levels were measured, with samples drawn at 45, 60, 90, and 120 minutes after injection in 25 patients. Five additional patients had sampling at 15 and 30 minutes as well as at the above times. MEASUREMENTS AND MAIN RESULTS: The highest concentration of bupivacaine was detected at 15 minutes. The mean concentrations at 15, 30, 45, 60, and 120 minutes were 0.86, 0.74, 0.31, 0.27, 0.23, and 0.22 microg/ml, respectively. This is well below the level of serious toxicity. Only four patients received 2.5 mg/kg or greater of bupivacaine. In these patients, mean serum levels were 1.1, 1.0, 0.28, 0.43, 0.9, and 0.29 microg/ml, respectively. CONCLUSION: Serum bupivacaine levels during sterilization using bupivacaine 0.5% without epinephrine for local anesthesia are well below the threshold for serious toxicity.

Anesthesia, Local↗
PubMed1994

The effect of nitrous oxide and carbon dioxide pneumoperitoneum on operative and postoperative pain during laparoscopic sterilization under local anesthesia.

STUDY OBJECTIVE: To compare carbon dioxide and nitrous oxide pneumoperitoneum with respect to intraoperative and postoperative pain during laparoscopic sterilization under local anesthesia. DESIGN: Randomized, double-blind study of pain during surgery and at 15 minutes, 1 hour, and 24 hours postoperatively. SETTING: Regional Medical Center, Memphis, Tennessee. PATIENTS: Women scheduled for laparoscopic sterilization under local anesthesia. Interventions. Forty-nine patients were randomized to carbon dioxide and 56 to nitrous oxide pneumoperitoneum. MEASUREMENTS AND MAIN RESULTS: Pain was assessed using a modified McGill pain questionnaire. Intraoperative pain was measured by the amount of supplemental narcotic required. Analgesic use in the recovery room and during the first 24 hours postoperatively was compared. Demographics for both groups were similar. The groups had no statistical differences in pain during surgery or at any of the postoperative time periods. Recovery room analgesia requirement was similar, but the nitrous oxide group used fewer pain tables (0.98 vs 0.42 tablets) in the first 24 hours. CONCLUSIONS: There is no difference in intraoperative and postoperative pain between nitrous oxide and carbon dioxide pneumoperitoneum for laparoscopic sterilization when used in conjunction with a protocol such as ours.

Administration, Oral↗
PubMed1994

A model for resident surgical training in laparoscopic sterilization.

OBJECTIVE: To measure the effects of a specific instructional program designed to teach residents laparoscopic sterilization. METHODS: The teaching module consisted of a 40-minute videotape and monograph, which each resident studied 1-3 days before beginning a 4-5-week rotation on which he or she performed laparoscopic sterilization procedures. The change in knowledge was measured by comparing pre- and post-test assessments. Twenty-three PGY-2 gynecology residents were administered the peer-reviewed and validated pre-test, which consisted of 31 multiple-choice questions covering the following aspects of laparoscopic sterilization: 1) indications and complications, 2) general aspects of sterilization, 3) sterilization methods, and 4) technical aspects of occlusive device application. A post-test, which consisted of the identical 31 items with the question order changed, was administered after the teaching module was completed. RESULTS: The mean number of correct answers on the post-test (27.2 +/- 2.3, range 22-31) was significantly higher (P < .05) than the mean number of correct answers on the pre-test (17.9 +/- 3.4, range 13-24). There was no difference in residence scores if the module was completed early or late in the academic year or during the first or second year that the program was in effect. CONCLUSION: This study demonstrates that knowledge of a specific surgical technique can be measured and that structured learning packages can be effective. Efforts to teach residents a specific curriculum can have a significant effect on their fund of knowledge. Other specially designed programs may be applicable to procedures commonly performed by gynecologic residents.

Curriculum↗
PubMed1994

Chromopertubation at laparoscopic tubal occlusion.

OBJECTIVE: To evaluate the role of chromopertubation following laparoscopic sterilization in terms of occlusive device displacement, infectious complications, and sterilization failures. METHODS: Five hundred consecutive women scheduled for laparoscopic sterilization were randomized to rings, electrocoagulation, or clips for tubal occlusion. Subjects were further randomized to chromopertubation or no chromopertubation. At chromopertubation, any occlusive device displacement or dye spillage was noted. Patients were followed postoperatively for sterilization failure or infectious complications. Statistical analysis used the chi 2 test. RESULTS: At chromopertubation, no device dislodgment, change in position, or dye spillage from the occlusion site was noted. Dye spillage from the end of the fallopian tube occurred in five patients, and immediate repeat tubal occlusion was performed. Six true sterilization failures occurred during the follow-up period. Despite elimination of five apparent failures in the chromopertubation group, there was no significant difference between the no-chromopertubation and chromopertubation groups with regard to failure rate. There were also no significant differences in postoperative wound infections or development of pelvic inflammatory disease. CONCLUSION: Chromopertubation at sterilization is associated with minimal complications but has limited value in eliminating sterilization failures.

Fallopian Tube Patency Tests↗
PubMed1993

Relationship of pelvic infection and chronic pelvic pain.

The approach to the patient with CPP with a history of PID remains a diagnostic challenge even for the experienced clinician. From the initial diagnosis of presumed PID to managing the pain that may result, using an approach that looks at all factors, not just antecedent PID, allows the practicing physician to avoid becoming too narrowly focused in his or her approach. A clinical starting point would assume all possibilities for pelvic pain and evaluate for each. Given the history of one or more episodes of PID, especially if documented with a prior laparoscopy, earlier investigation for adhesions could be justified in selected patients. If the pelvic examination further suggests a pelvic source, a laparoscopy performed early rather than late in the work-up would seem appropriate. The key to management of the patients who have CPP following PID is to use any and all available diagnostic and therapeutic modalities to identify the source(s) before assuming that the patient suffers only from the known sequelae of PID.

Chronic Disease↗
PubMed1993

Senior obstetric-gynecologic residents' perceptions of their surgical training, experiences and skill.

Senior obstetric and gynecologic residents' self-perceptions of surgical skill seem to be unrelated to the kinds of didactic experiences received or to the number of basic gynecologic procedures performed during training. These data offer further support for the need for a comprehensive reevaluation of the components of gynecologic surgical curricula; the cognitive, behavioral and psychomotor educational objectives of such training; and the methods by which the outcomes for these objectives are measured.

Clinical Competence↗
PubMed1993

The effect of same-day pregnancy testing on the incidence of luteal phase pregnancy.

OBJECTIVE: To assess the impact of same-day pregnancy testing on the incidence of luteal phase pregnancy (pregnancy in which conception occurs before sterilization). METHODS: Retrospectively, all patients (N = 1006) undergoing laparoscopic tubal ligations at the Regional Medical Center, Memphis, from May 1990 through December 1991 were reviewed for sterilization failures. Negative urine pregnancy tests were documented on all scheduled patients at their preoperative examination. After the first 401 sterilizations, same-day pregnancy testing with enzyme-linked immunosorbent assay (ELISA) pregnancy tests was instituted. We reviewed the records of all presumed sterilization failures as well as all patients with a positive pregnancy test on the day of surgery. Last menstrual period, ultrasound records, and date of delivery were analyzed to determine time of conception. RESULTS: Seven luteal phase pregnancies were discovered among the first 401 sterilization cases (17 per 1000). No luteal phase pregnancies occurred in the next 605 sterilizations after institution of same-day pregnancy testing. Eight patients' sterilizations were canceled because of a positive pregnancy test on the morning of surgery. If these patients had not been eliminated, the incidence of luteal phase pregnancies in this second group would have been 13 per 1000 sterilization procedures. CONCLUSION: Same-day pregnancy testing with an ELISA-type pregnancy test is a rapid, inexpensive, and effective means of reducing the incidence of luteal phase pregnancy.

Enzyme-Linked Immunosorbent Assay↗
PubMed1992

Male victims of sexual assault.

OBJECTIVE: To compare the demographics, physical findings, and assault characteristics of incarcerated, sexually assaulted men with those of nonincarcerated, sexually assaulted men. DESIGN: Case series of 99 adult male victims of sexual assault evaluated over a 3-year period. SETTING: Memphis Sexual Assault Resource Center, a nonhospital-based clinic that serves as the primary resource for sexually assaulted victims in the Memphis and Shelby County, Tennessee, area. PARTICIPANTS: All adult male victims of sexual assault evaluated at the Memphis Sexual Assault Resource Center during the study period were included in the study. Ninety-nine victims were studied, including 80 incarcerated men and 19 men from the community. RESULTS: The victims of sexual assault in the community group were older than the victims in the incarcerated group. Apart from the age difference and weapon use, there were no statistically significant differences between the incarcerated and nonincarcerated victims. CONCLUSIONS: The similarities between the two groups suggest that sexual assault of men may not be unique to prisons, and all men are potential victims. Further studies are required to better understand these crimes and to develop education and prevention programs.

Adolescent↗
PubMed1992

Tubo-ovarian abscess in postmenopausal patients.

We retrospectively reviewed 20 surgically confirmed tubo-ovarian abscesses in postmenopausal women for the period 1973 to 1989. Pain and bleeding were the two most common presenting symptoms. Nine of the 20 patients (45%) had recently had endometrial instrumentation. Fever and the presence of a pelvic mass and elevated white blood cell count, without evidence of peritonitis, were frequent findings on admission. At surgery, seven abscesses were already ruptured or leaking, 12 of 18 patients with both ovaries had unilateral abscesses, and dense adhesions were found in 11 patients. A common intraoperative complication was inadvertent bowel injury. Postoperative complications included fascial dehiscence, enterocutaneous fistula, deep venous thrombosis, and need for prolonged ventilatory support. Eight patients had a coexisting gynecologic malignancy. A high index of suspicion is required for early recognition of postmenopausal tubo-ovarian abscess. Prompt surgical exploration should be done to avoid occult rupture or sepsis.

Abscess↗
PubMed1992

Gynaecological teaching associates in the 1990s.

Chairmen of academic obstetrics and gynaecology departments in the USA and Canada were asked if they used gynaecological teaching associates (GTAs) and their opinions of their educational and cost effectiveness. Three-quarters of chairmen used GTAs and were satisfied with the educational aspects of GTA instruction. Departmental discretionary funds provided all or part of the GTA funding in 40% of departments and the medical school all or part of the GTA funding in 72%. As more monies came from departmental discretionary funds, chairmen were increasingly dissatisfied. Because the 1990s will be difficult financially, it was hypothesized that chairmen may eventually cancel GTA programmes as expendable 'luxuries'.

Attitude of Health Personnel↗
PubMed1992

Comparison of silastic rings and electrocoagulation for laparoscopic tubal ligation under local anesthesia.

OBJECTIVE: To compare objectively the pain associated with tubal occlusion by Silastic rings versus electrocoagulation during laparoscopic tubal ligation under local anesthesia. METHODS: Consecutive patients scheduled for laparoscopic tubal ligation under local anesthesia were randomized to Silastic rings (N = 50) or electrocoagulation (N = 52) as the method of tubal occlusion. Sterilization was performed under local anesthesia in a standard fashion. Bupivacaine 0.5% was used as the local anesthetic agent. Operative pain was measured based on intraoperative anesthesia requirements and a modified McGill pain questionnaire. This questionnaire was used to assess pain at 15 minutes, 1 hour, and 24 hours postoperatively. RESULTS: Demographics were similar for the two groups. Operative time was shorter in the Silastic-ring group (16.7 versus 21.8 minutes; P = .001), and this group also required less intraoperative anesthesia (P = .004). There were no statistical differences between the groups in self-reported pain intraoperatively or postoperatively. No patient in either group required antiemetics or pain medication in the recovery room. CONCLUSION: Silastic rings appear preferable to bipolar electrocoagulation for laparoscopic tubal sterilization under local anesthesia when long-acting local agents are used for tubal anesthesia.

Adult↗
PubMed1992

Randomized comparison of laparoscopy-assisted vaginal hysterectomy with standard vaginal hysterectomy in an outpatient setting.

OBJECTIVE: To compare outpatient laparoscopy-assisted vaginal hysterectomy with standard outpatient vaginal hysterectomy. METHODS: Fifty-six women scheduled for vaginal hysterectomy were randomly assigned to undergo either a laparoscopy-assisted vaginal hysterectomy with endoscopic staples (N = 29) or a standard vaginal hysterectomy (N = 27). There were no differences between the study groups with regard to age, gravidity, parity, preoperative indications, and previous operations. RESULTS: Twenty-eight of 29 laparoscopy-assisted vaginal hysterectomies and all 27 vaginal hysterectomies were completed without incident. When indicated, unilateral or bilateral oophorectomies were completed. The mean operating time was significantly longer for laparoscopy-assisted vaginal hysterectomy (120.1 versus 64.7 minutes). Fifty-three of the 55 patients completing surgery were discharged home by 12 hours from the time of admission. Complications with laparoscopic hysterectomy were related to the technical aspects of laparoscopy. The incidence of febrile morbidity was similar in the groups. Although patients having laparoscopy-assisted hysterectomy required statistically significantly more pain medication and had lower postoperative hematocrit measurements, this did not make a clinical difference in the postoperative courses. The mean hospital charge for laparoscopy-assisted vaginal hysterectomy was $7905 and for vaginal hysterectomy $4891. CONCLUSION: Other than cost, laparoscopy-assisted vaginal hysterectomy and standard vaginal hysterectomy appear comparable in patients who could otherwise undergo a vaginal hysterectomy.

Adult↗
PubMed1991

Vaginal cuff closure at abdominal hysterectomy: comparing sutures with absorbable staples.

To compare two methods of vaginal cuff closure during abdominal hysterectomy, 60 patients were randomized to one of two cuff-closure methods. The vaginal cuff was closed with three interrupted 0-Dexon sutures in 30 and with absorbable staples in 30. Both groups were similar with respect to age, gravidity, parity, preoperative indication, hemoglobin, and hematocrit. The operative technique and quantity of irrigation used was standardized. Operative blood loss was calculated by the weight method and an unactivated, medium flat Jackson-Pratt drain was left in place for collecting postoperative cuff cultures at 24 and 48 hours. The mean operative times in the suture group (97.4 minutes) and staple group (93.4 minutes) were not significantly different (P greater than .05). Cuff-closure time was more rapid (P = .0001) in the staple group (5.8 minutes) than in the suture group (9.3 minutes). Intraoperative cultures were positive in eight of 30 suture patients (26.7%) and eight of 30 staple patients (26.7%). Postoperative cultures at either 24 or 48 hours were positive in four women (13.3%) in the suture group and six (20%) in the staple group. Febrile morbidity occurred in six (20%) in each group. Three staple and two suture subjects developed a vaginal cuff abscess or hematoma, one of whom was readmitted to the hospital for intravenous antibiotics and draining of the vaginal cuff abscess. The presence of a positive vaginal cuff culture did not predict clinical outcome. Based on these observations and the increased cost of the stapling device, we conclude that there is no significant clinical advantage of surgical staples over traditional sutures for vaginal cuff closure at abdominal hysterectomy.

Adult↗
PubMed1991

Ovarian abscess arising within an endometrioma.

Ovarian abscess is a rare gynecologic entity; only 120 cases have been reported in the world literature. In contrast to the more commonly encountered tubo-ovarian abscess, tubal involvement is absent in the ovarian abscess. This report describes a case of an ovarian abscess arising de novo within an endometrioma. The woman presented with a 20-cm pelvic-abdominal mass with paracaval adenopathy and bilateral ureteral obstruction. Treatment with broad-spectrum antibiotics was unsuccessful. The surgical specimen revealed endometrial glands, stroma, hemosiderin-laden macrophages, and evidence of abscess formation.

Abscess↗